Acute and Chronic Inflammation
Path
is
Lots O’
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• A 22-year-old man develops marked right
lower quadrant abdominal pain over the past
day. On physical examination there is rebound
tenderness on palpation over the right lower
quadrant. Laparoscopic surgery is performed,
and the appendix is swollen, erythematous,
and partly covered by a yellowish exudate. It
is removed, and a microscopic section shows
infiltration with numerous neutrophils. The
pain experienced by this patient is
predominantly the result of the formation of
two chemical mediators.
Prostaglandin and Bradykinin
• A 40-year-old woman had bilateral silicone
breast implants placed two years ago. Since
that time, she has noted increased firmness
with slight deformity of the breast on the left.
The implants are removed, and there is
evidence for leakage of the implant contents
on the left. This cell type is the most
characteristic of the inflammatory response in
this situation.
Giant Cell
• A clinical study is performed of patients with
pharyngeal infections. Most of these patients
experience fever and chills. On physical
examination, the most common findings
include swelling, erythema, and pharyngeal
purulent exudate. Which of the following
types of inflammation did these patients most
likely have?
Acute Inflammation
• A 20-year-old man has experienced painful
urination for 4 days following spring break.
Urethritis is suspected, and Neisseria
gonorrheae is cultured. Numerous neutrophils
are present in a smear of the exudate from the
penile urethra. These neutrophils undergo
diapedesis to reach the organisms. Release of
this chemical mediator is most likely to drive
neutrophil exudation.
Complement C5a
An episode of marked chest pain brings a 51year-old man to the emergency room. An
angiogram reveals a complete blockage of the
left circumflex artery. This substance is
elaborated around the region of tissue damage
in the next 3 days as an initial response to
increase myocardial function and promote
healing?
Vascular Endothelial
Growth Factor (VEGF)
A 90-year-old woman has developed a fever and
cough over the past 2 days. Staphylococcus
aureus is cultured from her sputum. She
receives a course of antibiotic therapy. Two
weeks later she no longer has a productive
cough, but she still has a fever. A chest
radiograph reveals a 3 cm rounded density
whose liquefied contents form a central airfluid level. This is the most likely outcome
Abscess formation
A 35-year-old woman has been taking aspirin for
arthritis for the past 4 years. Her joint pain is
temporarily reduced. Radiographs of her
knees reveals continuing joint destruction
with loss of articular cartilage and joint space
narrowing. This pain reduction is most likely
to be the result of this diminishing chemical
mediator.
Prostaglandin
An inflammatory process that has continued for 3
months includes the transformation of tissue
macrophages to epithelioid cells. There are also
lymphocytes present. Over time, fibroblasts lay
down collagen as the focus of inflammation
heals. These events occur as an inflammatory
response to this infectious agent.
Mycobacterium
tuberculosis
A 37-year-old man has had nausea and vomiting
for 5 weeks. On physical examination he has no
abnormal findings. Upper GI endoscopy is
performed, and there is a 1.5 cm diameter
lesion in the gastric antrum with loss of the
epithelial surface. These findings are most
typical for this pathologic process.
Ulcer
A 15-year-old girl has had episodes of sneezing
with watery eyes and runny nose for the past 2
weeks. She has had similar episodes each spring
and summer when the amount of ragweed
pollen in the air is high. Her symptoms are most
likely to be mediated by the release of this
chemical mediator.
Histamine
This is excess interstitial fluid that can be
classified as a transudate or exudate.
Edema
This is one of the earliest manifestations
of acute inflammation.
Vasodilation
Within minutes following a bee sting, a 37-yearold man develops marked respiratory stridor
with dyspnea and wheezing. He also develops
swelling and erythema seen in his arms and
legs. An injection of epinephrine helps to
reverse these events and he recovers within
minutes. This chemical mediator is most
important in the pathogenesis of this man's
condition.
Histamine
These are the characteristics of an exudate.
Inflammatory extravascular fluid
High protein concentration
Specific gravity > 1.020
Usually due to  permeability
• These are characteristics of a transudate.
Fluid with low protein concentration
Specific gravity < 1.012
Permeability usually not increased
This is the hallmark of acute
inflammation.
Increased vascular
permeability
This is the increased transport
of fluids and proteins
through the endothelial cell.
Transcytosis
A 9-year-old girl sustains a small 0.5 cm long laceration
to her right index finger while playing "Queen of
Swords" with a letter opener. This substances, on
contact with injured vascular basement membrane,
activates both the coagulation sequence and the
kinin system as an initial response to this injury.
Hageman Factor (XII)
Margination
Rolling
Adhesion
Migration
During the first 6-24 hours, this cell will
be the predominant cell type in acute
inflammation.
Neutrophil